Gliederung

Objective

Traumatic interpeduncular subarachnoid hemorrhage (tiSAH), as seen on the initial computerized tomography (CT) scan is thought to correlate with accompanying brainstem lesions in patients with traumatic brain injury (TBI). The objective of this study was to investigate whether there indeed exists a correlation between tiSAH and brainstem injury in patients with TBI.

Methods

In 16 brain-traumatized patients with CT-proven tiSAH (12 male / 4 female, 13-74 years, median 37 years, mean GCS (Glasgow Coma Scale) 6 at admission magnetic resonance tomographic imaging (MRI) and motor (MEP) as well as somatosensory evoked potentials (SSEP) were performed within the first weeks after trauma.

Results

On MRI all patients showed supratentorial lesions, 6 patients callosal body lesions, but only 4 (25%) patients brainstem lesions despite tiSAH. In 3 of the 4 patients who had brainstem lesions on MRI, pathological EPs (absent potential or prolonged latency) were found. One patient proved to have a brainstem lesion on MRI but showed normal EPs. There was a good mean overall outcome as measured by the GOS (Glasgow Outcome Scale) of 4. There was no difference in outcome in the patient group with brainstem lesions.

Conclusions

It was believed that blood in the interpeduncular cistern as seen on the initial CT scan is an indicator of brainstem injury and poor outcome. The present study clearly showed, that this assumption is wrong: Only 25% of the patients with tiSAH indeed had a MRI and / or EP proven brainstem lesion. Furthermore there was no difference in recovery compared to patients without brainstem lesions.